This document proposes a parent education program for a NICU. It notes that over 3,800 infants were admitted to California NICUs in 2006 alone, directly impacting over 7,600 individuals. The proposed program would have two components: 1) Infant Care Education to teach parents skills like caring for their baby and doing kangaroo care and 2) Parent Care Support to address common emotional challenges for NICU parents like stress, guilt, and anxiety through resources like a parent buddy program. The effectiveness of the program would be evaluated based on the psychosocial well-being of parents and the length of infant hospitalizations. Similar parent education programs have been shown to reduce infant hospitalization by 4-8 days.

1. Running Head: NICU Parent Education Program
NICU: Parent Education Program Proposal
Kara McGregor
Child Life Administration & Program Development
Loma Linda University
Monday March 5, 2012

2. NICU: Parent Education Program 2
Executive Summary
A startling 3,801 infants were admitted to California NICUS in 2006 alone.
However, the facts do not stop there. If each of those infants were to have even one
parent by their side, supporting them through the hospitalization process, that
would result in 7,602 individuals who are directly affected by time spent in the
NICU. Sadly, babies are not the only victims robbed by NICU hospitalization, with
many NICU parents experiencing a loss of self-esteem, emotional resolve and the
dream they once held so dear of being a hands on parent.
While NICU hospitalization can be traumatic for infants and parents alike, it has
no right to rob parents of their dreams or desire of parenting a healthy child. With
each infant receiving the necessary medical care needed to grow and reach various
developmental milestones, it is essential that parents be given whatever resources
necessary to empower them to be the most educated and involved NICU parent
possible. However such expectations can only be reached by establishing a Parent
based Education program, one that will educate parents on how to care for their
infants while in the NICU in addition to educating parents about emotions that they
themselves may encounter. Dependent on parents for more needs then we think,
premature babies will fail to reach their full potential and thrive as members of our
society children if their mothers fail to meet the emotional and physical needs they
so dearly crave, making it essential that any and all NICU parent have access to this
Parent Education based program.

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Statement of Need
Considered the last line of defense for premature babies, today’s Neonatal
Intensive Care Units becomes the training ground for babies born with health and
developmental complications. In 2006, alone, 3,801 infants were admitted to
California NICUS. However, admittance to a NICU is not a one-person experience but
also involves parents and extended family. For premature babies, their time in the
NICU shapes not only them but their parents as well, often eliciting a host of
emotional and psychological challenges that can follow infants and their parents
through the remainder of their lives (Bergman, 2011) .
According to Lefkowitz, Baxt, and Evans (2010), the most notable stressor
faced by NICU parents is having to watch their underdeveloped infant endure the
physical stress and pain associated with hospitalization. The stress felt by parents
does not stop there though. In fact that is only the starting place. In addition to
witnessing their pint-size infants endure treatment after treatment, parents are
quickly flooded with a host of other emotional challenges (Lefkowitz et. al., 2010).
From feeling like a helpless foreigner in a new environment, to wanting more than
anything to simply hold and protect their child, NICU parents face a multitude of
emotions such as fear, anger, grief and regret (Turan, Basbakkal & Ozbek, 2010).
Parental self-esteem is also directly affected by NICU hospitalization, with many
mothers doubting themselves and questioning pregnancy related decisions they
made prior to giving birth (Turan et al., 2010). If not caught, such emotional
difficulties can directly affect an individual’s ability to parent, and in some cases

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develop into Post Partum Depression, Acute Stress Disorder or even Post Traumatic
Stress Disorder (Lefkowitz, 2010) . Such disorders have been known to affect 10-
15% of NICU mothers (Lefkowitz, 2010).
NICU mothers diagnosed with ASD and PTSD reported symptoms such as
flashbacks, avoidance, sleep difficulties as well as dissociative symptoms (Lefkowitz,
2010). Such symptoms directly affect ones ability to parent, and have been shown to
result in negative infant outcomes such as, avoidant attachment, behavioral and
emotional difficulties and deficits (Bergman, 2011).
Most central to the needs of an infant are attachment, specifically the time
spent with mom, shortly after birth and in the weeks to come (Bergman, 2011).
Proper attachment is essential for all premature infants on not just an emotional
level but physically speaking as well (Bergman, 2011). Infants who fail to bond with
caregivers at birth experience both short and long-term complications (Melnyk,
2006). In the short term, premature babies with attachment deficits typically endure
longer hospitalization and greater medical complications (Melnyk, 2006). As stated
by Bergman, (2010) The long-term effects are as concerning if not more. Infants
who fail to develop health bonds with their mothers are shown to have various
cognitive emotional, and attachment difficulties that often plague the rest of their
lives, effecting everything from their self-image to their ability to live a healthy life
(Bergman, 2010).
As evidence above, the infant road to wellness is difficult for parent and child
alike. While the infant fights for physical wellness, the parent is often enduring an
emotional battle, one that must be addressed and properly treated (Melnyk, 2006).

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If left untreated, not only will the infant fail to thrive physical and emotionally, but
the parent will fail in their role as caretaker, making the child vulnerable to various
cognitive and emotional deficits (Bergman, 2010). Deficits that can be avoided by
simply educating parents with the resources needed when caring for a premature
baby (Melnyk, 2010).
Project Description
Aimed at empowering parents to be active participants in their child’s health
care, my hope is that by offering various resources to NICU parents, they will walk
away with a healthy child and the confidence needed to oversee their infants long
term care and growth. My program will have two aspects, Infant Care Education and
Parent Care Support. Convinced that the only way parents can effectively care for
this children is by knowing how to, the Infant Care Education will equip parents with
the basic skills needed to oversee their child’s medical related needs at home.
Equally as important is the Parent Support Care which will address the emotional
and psychological road blocks often encountered by NICU parents, equipping them
with the resources necessary to overcome such obstacles while rising to be the
parent they have always dreamed of being.
The first aspect of Infant Care Education will be for a Child Life Specialist to
educate parents about the machinery they first see when entering the NICU,
specifically the monitors that are beeping, the wires that are attached to their baby’s
stomach, and their intended use. Following the introduction of various machines,
the parent will then be instructed on how to safely touch their premie without
offering too much stimulation. Based on the (nurses) assessment of the parents
comfort level, the next phase in the process of Infant Care Education would be to

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instruct them on how to give their baby a sponge bath. Simple in theory, such tasks
can take parents from being sideline supporters to hands on caretakers, giving their
baby the touch he or she so desperately desires will instilling confidence in the
minds of these new parents.
After being trained in how to tend to the daily needs of their infant, the parent
will then be educated about Kangaroo Care, the benefit it could have on their infants
development, and their role as a parent participating in Kangaroo Care. Kangaroo
Care involves skin to skin contact between mother and child, often for extended
periods of time and sometimes in the form of breast feeding (Bergman, 2010). An
essential part of mother child bonding following the child’s birth, Kangaroo Care is
shown to help regulate the infants vital signs and develop relational bonds between
mother and child, resulting in an infant who is cognitively more on par, emotionally
more stable and physically stronger (Bergman, 2010). In addition, the bonding that
takes place between mother and child is also shown to reduce parent stress because
of the attachment taking place, a huge asset to NICU parents who are often
overloaded by stress (Bergman, 2010). If NICU parents can combat stress by simply
holding their child, then the medical staff must employ all means necessary to allow
parents to start that bonding process as soon as the infant is large enough to be held
(Bergman, 2010).
The second component of the Parent Education Plan is to address the
emotional and psychological difficulties often encountered by NICU parents. The
NICU experience is different for every parent, however a number of studies have
concluded that the most common emotions felt by NICU parents are those of

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anger, sadness, guilt, fear, anxiety and disappointment (Turan, 2008). Such
emotions are common responses to the stress experienced from long hours
spent by their infants isolate (Turan, 2008). Despite being common, it is
essential that NICU parent be given the proper educational and emotional
support needed to weather the emotional storm, otherwise they may develop
PTSD or Postpartum depression (Lefkowitz, 2010).
The emotional component of Parent Care Support would be also be
performed by the same Child LIfe Specialist. Typically the Educator or Specialist
would sit down one on one with the parents following the admittance of their
child. The Specialist would layout a brief sketch of what Neonatal hospitalization
can look like as well as challenges that parents can expect to encounter. After
getting to know the parents, it is then the specialist role to make a general
assessment of the parents stress level and coping abilities. Based on the
Specialists assessment, they can then refer the parents to the hospitals Parent
Buddy Program if they believe it would be of benefit to the parents. The Parent
Buddy Program is mentor like support group where a former NICU mother is
assigned to a new NICU mother, helping to offer whatever emotional and
practical support that may be needed during their infants hospitalization.
When it comes to the evaluation of my program, there are a number of ways
in which its effectiveness will be assessed. For starters, the psychosocial well
being of parents will be monitored closely by the Child Life Specialist while in
the NICU and also assessed through follow-up interviews and surveys after their
baby is released from the hospital. Structured to resemble other NICU based

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Parent Programs that have proven successful, if parents stress levels decline
while their coping abilities and confidence grows during hospitalization, then
our Parent Care Support aspect will be deemed successful. However, this
program is designed to more then just treat the emotional needs of parents but
also has the power to shorten the hospitalization of premature infants. A similar
parent based education program called the COPE (Creating Opportunities for
Parent Empowerment) reduced the hospitalization of preterm infants born at
26-34 weeks by 4 days, and the hospitalization of infants under 32 weeks by 8
days. With that said, the length of hospitalization will also be monitored for all
patients and if we can indirectly save our hospital money and speed up the
recovery by implanting this program, then it will once again be considered a
complete success.
Cost-Effectiveness of a Parent Education Program

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Cost of Employing a NICU Child Life Specialist
1. Organization Information
Founded on the core principles of care, compassion and accessible health
care for all children, Inland Valley Regional Children’s Hospital seeks to offer more
than a diagnosis but a holistic approach to health care that treats children and
parents alike. Convinced that the road to wellness is not rooted in medicine alone,
we consider the family to be an integral part of our health care team and as result
desire to educate and equip them with the resources necessary to fight their child’s
illness head on. Established in 1970, Inland Valley Regional Children’s Hospital has
become a symbol of compassion, integrity and quality health care in region so badly
in need of it.
Currently serving upwards of 70,000 children per year, Inland Valley
Regional Children’s Hospital has become a haven for the sickest children within our
Core Compensation Total %
Base Salary $25.00/hourly rate. = $ 48,000 77.9%
Bonuses N.A
Social Security 6.25% $3,000 = 4.87%
401k/403B: 3.25% $ 1560 = 2.53%
Disability: 0.5% $240 = 0.38%
Healthcare: 12% $ 5,760 = 9.35%
Time Off: 6.25% $ 3,000= 4.87%
Total Compensation $61,560 = 100%

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region, offering services in Oncology, Rehab, Cardiology, Neurosurgery,
Rheumatology, Neonatalogy, and Emergency Medicine to name a few of our
specialties. Our patients are served in both inpatient and outpatient settings, with
the most critically ill receiving round the clock support on one of our 6 inpatient
units. Desiring to offer more than a diagnosis and treatment plan, the staff at Inland
Valley Regional Children’s Hospital believe that a full recovery can only occur by
addressing every aspect of wellness. From physical to emotional, relational and
interpersonal, we have chosen to make our team of fifteen Child Life Specialist a
central component of our health care team, addressing the various needs of children
and families require during hospitalization.
2. Conclusion 2 paragraphs